مجله دانشکده پزشکی اصفهان
پیاپی 489 (هفته اول مهر ماه 1397)

The aim of the present study was to investigate the effect of time of day on ischemic response, and exercise test indexes in persons with symptoms of chronic stable angina.

We selected 24 volunteers with symptoms of chronic stable angina aged 45 to 65 years with average age of 55.4 ± 6.2. All the participants performed exercise test with treadmill (Bruce protocol) at two times, morning (8-10 am) and evening (3-5 pm) with interval of 96 hours. Considering individual ischemic responses (rate of ST segment depression during recovery and testing, starting stage of changes, and the number of leads with ST segment depression), the risk of developing coronary artery disease (CAD) was graded as negative, and low-risk and high-risk positive, and eventually the risk of CAD development and change of exercise test indexes [metabolic equivalents (METs), heart rate, blood pressure, rate-pressure product (RPP), time, distance, and rate of perceived exertion] were compared between morning and evening exercise tests. Findings: The subjects developed more intense ischemic response in the evening exercise test (rise of ST segment depression, the start of ST segment depression at earlier stage, and increasing number of leads) (P < 0.5). But exercise test indexes did not show any significant change between morning and evening exercise test (P > 0.5).

Ischemia response is considered as the most important achievement of exercise test, subject to the time of exercise test, but it is not clear enough that which test (morning or evening) is well indicative of coronary artery stenosis, so it needs to be investigated further.

Apoptosis has recently sparked interest among sport science researchers; since they have found out, both necrosis and apoptosis tend to occur during training. The present research was, therefore, designed to investigate and compare the possible adaptation of the apoptotic process following eight weeks of endurance and resistance training.

Twenty-one dormitory boy students were randomly assigned to three groups of endurance, resistance, or control. The training was performed for eight weeks, three sessions per week. Blood samples were taken before and after the training, and BC12 and BAX indexes were measured using the enzyme-linked immunosorbent assay (ELISA) method. The data were analyzed using a one-way ANOVA, with the significance level of P < 0.050. Findings: There was a significant difference in BC12 changes between the three groups (P = 0.002), as well as between the endurance with control (P = 0.002) and resistance with endurance (P = 0.014) groups. But there was no significant difference between the resistance and control groups (P = 0.770). No significant differences were observed in BAX (P = 0.216) and the BCL2/BAX ratio (P = 0.092) between the groups.

The present study showed that eight weeks of training, irrespective of training type, could result in positive effects on the apoptotic factors. Training type is also considered as effective in the scale and type of changes. Therefore, it seems that, with respect to the apoptotic process in the body, regular exercise with normal intensity could take on a greater importance than the type of training.

Most patients with breast cancer refer to their doctor when their disease is in the advanced stage. Considering the lack of study on the causes associated with delay in management of patients in Isfahan, Iran, this study aimed to examine factors related to the delay in the care of patients with breast cancer.

In this cross-sectional study, 70 patients with breast cancer who referred to Omid and Alzahra hospitals in Isfahan were interviewed. Then, based on the researcher-made questionnaire which included demographic information, patient delay factors, delay factors of health and treatment system, referring and treatment times, and information on the condition of cancer, the factors associated with the delay in patient care were assessed. Findings: The mean time was 4.67 ± 1.57 months from symptoms appearance to the referral to physician, and 7.21 ± 2.89 months from the presence of symptoms to the diagnosis. The mean score of the patient delay was also relatively high.

Due to the fact that the most prevalent reason for management delay in patients with breast cancer is patient delay in going to a physician to perform diagnostic procedures, appropriate control and symptom training

Coincidence of systemic lupus erythematosus (SLE) and psoriasis is rare, but by consideration of skin involvement in both diseases and exacerbation of psoriasis with routine anti-malaria remedies used for lupus, assessment of coincidence of two diseases is important. In the current study, coincidence of psoriasis in cases with active SLE was assessed.

This was a cross-sectional study on 148 cases with active SLE performed during the years 2015-17. Lupus activity was assessed based on Systemic Lupus Erythematosus Disease Activity Index-2K (SLEDAI-2K). Then, psoriasis was evaluated in patients. Demographics of patients were recorded as well. Findings: Mean score of SLEDAI-2K was 19.77 ± 14.10. Duration of SLE and score of SLEDAI-2K had significant association (P = 0.001, r = 0.294). Gender distribution in psoriasis was significant (P = 0.019). There was no association between psoriasis and patients' age (P = 0.08), duration of SLE (P = 0.316), and SLEDAI-2K score (P = 0.295).

Mean age of patients, duration of SLE, and mean score of lupus activity were not in association with coincidence of psoriasis and SLE, but gender distribution of psoriasis among patients with active SLE was probably more among men.

Postoperative shivering is a common complication of surgical procedures under spinal anesthesia. The aim of this study was to determine the preventive effect of different doses of tramadol injection on shivering during and after lumbar orthopedic surgery under spinal anesthesia as compared to control group.

In a clinical trial study, 128 patients underwent lower limb orthopedic surgery in 4 groups of 32 patients received 0.5, 0.75, and 1 mg/kg, tramadol and normal saline with equal volume, 5 minutes before spinal anesthesia. The incidence of postoperative shivering was compared in four groups. Findings: A total of 11 patients suffered from postoperative shivering, 1 (6.2%), 2 (1/5), and 1 (2.6%) received tramadol 0.5, 0.75, and 1 mg/kg, respectively, and 7 (17.9%) were of the control group. The incidence of shivering in the control group was significantly higher than other groups (P = 0.021).

In this study, all three doses of 0.5, 0.75, and 1 mg/kg of tramadol were effective in preventing postoperative shivering, but the dose of 1 mg/kg was more effective. Therefore, a dose of 1 mg/kg tramadol seems to be a more appropriate dose for controlling postoperative shivering.